ERAS® Cardiac Society Turnkey Order Set for Patient Blood Management: Proceedings from the AATS ERAS Conclave 2023
Objectives: There are multiple published guidelines regarding comprehensive patient blood management, centered on the three pillars of patient blood management, manage preoperative anemia, minimize blood loss, and tolerate intra/postoperative anemia. We sought to create an order set to facilitate widespread implementation of evidence-based cardiac surgery patient blood management.
Methods: Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set for patient blood management. Orders derived from consistent Class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the TKO in bold type. Selected orders that were inconsistently Class I or IIA, Class IIB, or supported by published evidence, were also included in italicized type.
Results: Preoperatively there are strong recommendations to screen and treat preoperative anemia with iron replacement and erythropoietin, and to discontinue DAPT if the patient can safely wait for surgery. Intraoperative orders outline the routine use of an antifibrinolytic agent, cell saver, point of care viscoelastic testing, and use of a standard transfusion algorithm. The order set also reflects strong recommendations intraoperatively and postoperatively for agreed upon hemoglobin thresholds to consider transfusion of packed red blood cells. A hemoglobin threshold should be adopted according to local team consensus and should trigger a discussion regarding transfusion.
Conclusion: The benefit of a multidisciplinary PBM care pathway in cardiac surgery has been well established, yet implementation remains variable. Utilizing recommendations from existing guidelines, we have created a turnkey order set to facilitate the implementation of patient blood management.
Keywords: Critical Care; Enhanced Recovery After Surgery; Patient Blood Management; Perioperative Care; Transfusion.
Salenger R, Hirji S, Rea A, Cangut B, Morton-Bailey V, Gregory AJ, Arora RC, Grant MC, Raphael J, Engelman DT; ERAS Cardiac Working Group. ERAS® Cardiac Society Turnkey Order Set for Patient Blood Management: Proceedings from the AATS ERAS Conclave 2023. J Thorac Cardiovasc Surg. 2023 Oct 20:S0022-5223(23)00991-1. doi: 10.1016/j.jtcvs.2023.10.034. Epub ahead of print.